Findings in a study reported by Mullen and colleagues for the Children’s Oncology Group in the Journal of Clinical Oncology suggest that routine computed tomography (CT) surveillance may not be necessary for recurrence detection in favorable-histology Wilms tumor.

The study was a retrospective analysis involving 281 patients with recurrent, unilateral, favorable-histology Wilms tumor from the 5th National Wilms Tumor Study. The primary objective was to determine whether surveillance with CT was associated with improved overall survival after recurrence compared with chest x-ray and abdominal ultrasound.

Relapse Detection and Survival

The estimated 5-year overall survival rate after relapse among all patients was 67%. Recurrence was detected by signs/symptoms in 25% of cases, by chest x-ray/ultrasound in 48.5%, and by CT in 26.5%. Five-year overall survival rates were 59% with detection by signs/symptoms and 70% with detection by surveillance imaging with either CT or chest x-ray/ultrasound (P = .23).

Patients with recurrence detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with signs/symptoms (0.91 years) and chest x-ray/ultrasound (0.86 years; overall P = .003). For recurrences detected by surveillance imaging, a greater number of tumor foci at relapse (P < .001) and size of the largest focus greater than 2 cm (P = .02) were associated with poorer overall survival. There was no difference in 5-year overall survival after relapse when recurrence was detected by CT vs chest x-ray/ultrasound (65% vs 73%, P = .20).

The investigators concluded, “In patients with favorable-histology [Wilms tumor], elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health-care costs.”

The study was supported by grants from the National Institutes of Health, National Cancer Institute, and Harvard Medical School Eleanor and Miles Shore Fellowship Program.

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